Taking the RAC Not-So-Open-Door Policy to Washington

It wasn't even as thrilling as a high school trek to our nation's capital, but it was exciting to participate in an annual lobbying effort as part of the spring legislative meeting of the National Association of Rehab Agencies and Providers (NARA) last week. The NARA initiative took small contingencies of rehab business owners to visit their respective state delegations in both the Senate and the House of Representatives last Friday.

A key issue of concern on the legislative agenda for most outpatient rehab providers, including NARA, is the repeal of the therapy caps, which limit Medicare beneficiaries to $1,840 annually in physical therapy (including speech-language pathology) and $1,840 annually in occupational therapy services.

Senator John Ensign (R-NV) introduced legislation on Jan. 6. According to Senator Ensign, "the Medicare Access to Rehabilitation Services Act would permanently repeal the Medicare beneficiary therapy caps, an arbitrary restriction that prevents many seniors from receiving much-needed therapy."

I joined executives from the Lake Centre for Rehabilitation (with six therapy locations in north-central Florida) in calling on members of the Florida delegation. Our mission was to ask them to sign on to the Medicare Access to Rehabilitation Services Act (S 46/HR 43) introduced by Senators Ensign, Blanche Lincoln (D-AR), Susan Collins (R-ME), and Ben Cardin (D-MD), along with Representatives Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO).

Not-So-Open-Door Policy

Key to my visit to Capitol Hill was visiting the offices of Florida's senators, Mel Martinez (R-FL) and Bill Nelson (D-FL), to ask for their review and consideration of the therapy caps bill and to plead my case for a more open-door policy on the CMS-sponsored RAC provider outreach sessions. I had prepared a three-minute executive summary of my concerns on the CMS/RAC "not-so-open-door policy" and ran it by our NARA lobbyist (to test for effectiveness), and since Florida was a RAC demonstration state in 2007, the issues and concerns of providers were well known in offices. I felt confident in making my key points without having to over explain and get mired in minutiae.

At Senator Nelson's office I met with Legislative Assistant Madeline Otto, hoping I would get a sympathetic ear, but instead I got a quick mandate: she wanted to be informed of any future meetings that excluded providers. WOW! I promised to send her the CMS/RAC provider outreach schedule, which clearly shows that there has been no opportunity since the March rollout for Florida's non-hospital, non-physician providers to participate in the RAC information sessions.

I was so energized that I felt like I was walking on air as I proceeded over to the Hart Senate Office Building to meet with Taylor Booth, research assistant to Senator Martinez at the Office of the Special Committee on Aging. Taylor and I talked baseball for a few minutes -- he likes the Cubs, I like the Rays -- but once the formalities were set aside I laid out my three-minute speech again. He started laughing a little, and I wondered what in the world I could have said to invoke a giggle. I asked, and he replied that most providers come to the senator's office complaining of how the RAC process has been treating them (he thought it was ironic that another group of providers just wanted a seat at the table to find out what was going on). I had to agree that this warranted the chuckle on his part.

When I explained Senator Nelson's office's interest in hearing more about providers being excluded from the CMS/RAC outreach, Taylor indicated that the two Florida senators often work together to handle constituent concerns, and this was such an example: he too requested follow-up information, and promised the opportunity for a collaborative effort. I already have followed up with both Senator Nelson's and Senator Martinez's offices, thanking them for their time and providing them with the "goods": the CMS/RAC provider outreach schedule that pretty much makes the case for outpatient therapy providers and other Part B providers being excluded from the process. I'll be sure to keep you posted.

Oh, by the way: as I left the left the Special Committee on Aging Office, Taylor said, with a wink, that at Senator Martinez's office they understand being in the minority and not having a seat at the table.

Mission Accomplished.

About the Author

Nancy Beckley is a co-founder and President of Bloomingdale Consulting Group, Inc., providing consulting services to the rehab professional. Nancy is certified in Healthcare Compliance by the Healthcare Compliance Board, and serves on the Part A and Part B Provider Outreach Education and Advisory Panel for First Coast Services Options (Florida Medicare). She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities

Nancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practices. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Mondays, where she serves as a senior national correspondent.

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